The California Medical Assistance Program, or Medi-Cal, is California’s version of the Medicaid program. Medi-Cal is a need-based program that offers health care benefits to low-income individuals. Medi-Cal is funded by California state taxes as well as by federal funds. To qualify for Medi-Cal, one must be a California resident.
Who Is Eligible for Medi-Cal?
Coverage under Medi-Cal is based on an individual’s level of financial need. Disability is also a key factor in determining eligibility and coverage. Individuals who fit the following groups may qualify for Medi-Cal:
1. Public Assistance
Those who automatically qualify for Medi-Cal include individuals who are 65 or older, are blind or disabled, and receive Supplemental Security Income (SSI)/State Supplementary Payment (SSP).
2. Medically Needy
Those who are "medically needy" include individuals who are 65 or older, blind or disabled, and meet the family requirements of the California Work Opportunity and Responsibility to Kids (CalWORKs).
3. Medically Indigent
The following people may qualify for Medi-Cal because they are considered medically indigent:
- Pregnant women without access to public assistance programs (such as CalWORKs)
- Individuals between the ages of 21 and 65 who reside at nursing facilities
- Individuals under 21 who receive public funds
- Several categories of children including those who qualify for various state programs
4. Special Programs
The following people may qualify for all or some of the Medi-Cal coverage by fitting into the following groups:
- Pregnant women who can’t afford health care, even if they have an income
- Young children (infants, those ages 1 to 6, those ages 6 to 18)
- Noncitizen victims of serious crimes, including human trafficking
- Former foster care children who have not reached 21 yet and were still in the foster care on their 18th birthday
- Individuals in special treatment programs such as dialysis, breast, and cervical treatment programs
- Depending on immigration status, immigrants who would otherwise qualify for the Medi-Cal
5. Persons with Disability
For an adult to qualify for the Medi-Cal coverage based on disability, the following criteria must be satisfied:
- Sever physical/mental disability
- Persisted for at least 12 months
- Prevented work during those 12 months
- It may possibly result in death
For a disabled child to qualify for the Medi-Cal coverage, the following criteria must be met:
- Sever physical/mental disability
- Listed as disabling childhood condition
- Or, it must be so sever as to prevent child normal daily activities
Even before disability is established, a disabled person may qualify for Medi-Cal coverage based on the presumption of his disability.
Assets, Property, and Income: What Matters for Medi-Cal Coverage?
In general, the higher your income, the more you will have to pay towards your medical bills. Concerning assets, Medi-Cal caps the value of the assets an applicant may posses. However, the rules are complex, and certain assets may not be counted. Advanced planning with a qualified lawyer may be the best option.
Should I Contact an Attorney about Medi-Cal Eligibility?
The Medi-Cal application process is complicated and many applicants will not be approved because they make errors such as incorrectly stating their assets. Therefore, you may wish to contact a qualified personal injury attorney to help you become eligible for Medi-Cal benefits.